HPV-associated Cancers

Introductory video transcript:
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Course Overview

Human papillomavirus (HPV) is a common virus best known as the agent that causes benign warts. However, of the more than 100 types of HPV, about 13 types have been documented as “high risk”; that is they are associated with the development of human cancers.  HPV-related cancers include those of the cervix, vulva, and penis as well as cancers of the rectum, anus, and oropharynx.  Many of these diseases are preventable through HPV vaccination. In this course, a multidisciplinary faculty team discusses HPV biology, the specific cancers that are associated with HPV, the value of and recommendations for HPV vaccination for children, and coverage of conditions diagnosed via the “Breast and Cervical Cancer Early Detection Program”.

Accreditation/Credit Designation

The University of Texas MD Anderson Cancer Center designates this internet enduring material for a maximum of 6.25 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.



Lois M. Ramondetta, M.D.Introduction to Human Papillomavirus-related Diseases   Top of Page
Presenter: Lois M. Ramondetta, M.D.
Professor, Gynecologic Oncology and Reproductive Medicine



Summary: “Almost all will be infected with at least one type of human papillomavirus at some point in their life,” says Dr. Lois Ramondetta, Professor of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center. In her lecture, “Introduction to Human Papillomavirus–Related Diseases,” Dr. Ramondetta discusses the prevalence of HPV infections across the United States and the early effects of HPV vaccination on this prevalence. She also describes the data that support the safety and efficacy of the HPV vaccine and introduces various HPV-associated cancers.


Karen A. Storthz, Ph.D.Biology of Human Papillomavirus   Top of Page
Presenter: Karen Storthz, Ph.D.
Professor Emerita, Diagnostic and Biomedical Sciences
The University of Texas Health Science Center at Houston School of Dentistry

Summary: Dr. Karen Storthz, Professor Emerita in the Department of Diagnostic and Biomedical Sciences at The University of Texas Dental Branch, has studied human papillomavirus (HPV) and its role in oropharyngeal and cervical cancer for more than 30 years. In her lecture, “Biology of Human Papillomavirus,” she discusses the diversity of HPV types and describes the benign and malignant diseases that HPV causes. Beginning with a brief history of the research advances that increased our understanding of HPV biology and led to the development of HPV vaccines, she explains HPV gene function and viral replication and the role of viral E6 and E7 proteins in deregulating the cell cycle, leading to malignant transformation. By showing clinical photos of common benign lesions and cancers caused by HPV, she contrasts low-risk and high-risk HPV types and explains the uncommon but devastating process of malignant transformation of some HPV types.


Kathleen Schmeler, M.D.Cervical Cancer   Top of Page

Presenter: Kathleen Schmeler, M.D.
Associate Professor, Gynecologic Oncology and Reproductive Medicine


Summary: “In the United States, there are an estimated 12,360 new cases and approximately 4000 deaths from cervical cancer per year. It’s the 14th most frequent cancer among women. However, in low- and middle-income countries, cervical cancer is the first or second leading cause of cancer death among women, with over 400,000 women dying per year,” says Dr. Kathleen Schmeler, Associate Professor of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center. In her presentation “Carcinoma of the Cervix,” she describes the epidemiology of cervical cancer, discusses cervical cancer screening and prevention, and explains the appropriate treatment for early-stage, locally advanced, metastatic, and recurrent disease.
Lois M. Ramondetta, M.D. 

Presenter: Lois M. Ramondetta, M.D.
Professor, Gynecologic Oncology and Reproductive Medicine


Summary: “Cervical cancer is a huge problem in the world today,” says Dr. Lois Ramondetta, Professor of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center. In the first lecture of her in-depth, two-part series “Management of Local-regionally Advanced and Recurrent Cervical Cancer,” Dr. Ramondetta discusses the usual presentation and survival rates of women with local-regionally advanced cervical cancer and explains standard treatment approaches for this disease. She also discusses the determinants of local-regional recurrence of cervical cancer. She expresses optimism that advanced cervical cancer can be prevented in the future thanks to three HPV vaccines approved by the US Food and Drug Administration. In the second lecture in the series, Dr. Ramondetta discusses the challenge of treating recurrent cervical cancer. She discusses appropriate use of surgery and radiation therapy in women with recurrent disease. She also describes chemotherapy and targeted therapy and response rates in women with recurrent and advanced cervical cancer. She concludes by discussing the important role of supportive care in the treatment of women with recurrent and advanced cervical cancer.

Andrea Milbourne, M.D.

Presenter: Andrea Milbourne, M.D. 
Department of Gynecologic Oncology and Reproductive Medicine


Summary: “The current recommendation for cervical cancer is to start screening at age 21 regardless of sexual history,” says Dr. Andrea Milbourne, Professor of Gynecologic Oncology & Reproductive Medicine at The University of Texas MD Anderson Cancer Center.  In her lecture “Cervical Cancer Screening,” Dr. Milbourne discusses the guidelines for the initiation and frequency of cervical cancer screening and the advantages and disadvantages of various screening modalities. Dr. Milbourne also emphasizes that although the prevalence of cervical cancer is decreasing, screening modalities that are more sensitive and more specific than the ones currently in use are urgently needed.



Anal Cancer   Top of Page
Presenter: Cathy Eng, M.D.
Associate Professor
Department of Gastrointestinal (GI) Medical Oncology

Summary: “Anal cancer will affect more than 7000 individuals in 2015, and 950 of these individuals will unfortunately succumb to the disease “, says Dr. Cathy Eng, Professor of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center. In her lecture, “Anal Cancer: Overview of the Treatment of Squamous Cell Carcinoma (SCCA) of the Anal Canal,” Dr. Eng discusses how to identify risk factors associated with anal cancer, with special emphasis on the role of human papillomavirus (HPV) as the most commonly sexually transmitted infection. Dr. Eng discusses diagnosis and staging of patients with anal cancer and explains the role of chemoradiation in the treatment of patients with locally advanced disease. She then further highlights some of the ongoing studies in metastatic disease. Dr. Eng also emphasizes the importance of HPV vaccination and screening given the underutilization of the HPV vaccine in the United States, reinforcing the need for both girls and boys to be vaccinated at the appropriate ages.


Kristina R. Dahlstrom, Ph.D.Erich M. Sturgis, M.D., M.P.H.Oropharyngeal Cancer   Top of Page
Presenter: Kristina R. Dahlstrom, Ph.D.
Instructor, Head and Neck Surgery
Presenter: Erich M. Sturgis, M.D., M.P.H.
Professor, Head and Neck Surgery

Summary: “To date more than 150 types of HPV have been described. About 40 of these infect the genital tract and potentially the oral cavity and the oropharynx,” says Kristina R. Dahlstrom, Ph.D., an instructor in the Department of Head and Neck Surgery at The University of Texas MD Anderson Cancer Center. In this lecture, “Oropharyngeal Cancer: Epidemiology,” Dr. Dahlstrom describes the role of HPV in oropharyngeal cancer, risk factors for the disease, why HPV-associated cancers are becoming an epidemic, and trends and incidence in survival. She also talks about methods for prevention of HPV-related oropharyngeal cancer, which includes a newly FDA approved HPV nonavalent vaccine.

When oropharyngeal cancer is HPV-related, there typically are no symptoms, but there may be a lump in the neck. In his lecture, “Oropharyngeal Cancer: Clinical Implications of the HPV Epidemic,” Erich M. Sturgis, M.D., Professor of Head and Neck Surgery and Epidemiology, describes the pathophysiology of HPV infection and malignant transformation, as well as the clinical differences between HPV-positive cancers and HPV-negative cancers. He also discusses current clinical trials.


Penile Cancer   Top of Page
Presenter: Curtis A. Pettaway, M.D.
Department of Urology

Summary: Penile cancer is a devastating disease associated with human papillomavirus (HPV). Although penile cancer is relatively rare in developed countries, it “is much more prevalent in underdeveloped areas of the world. The age of diagnosis occurs in men in their fifties and sixties when they are largely still sexually active. However, there are many steps along the way [toward malignancy] that we can potentially take to decrease or even wipe out penile cancer, making it a model of preventable disease,” says Curtis A. Pettaway, MD, Professor of Urology. In his lecture, entitled “HPV and Penile Cancer: Diagnostic and Therapeutic Implications,” Dr. Pettaway explains the association between HPV and penile cancer and describes the potential mechanisms of pathogenesis for HPV in penile malignancy. He discusses the epidemiology, pathogenesis, natural history, staging, and management of primary penile cancer and the inguinal region and describes steps to prevent penile cancer. Additionally, Dr. Pettaway presents new data on HPV and penile cancer prognosis, emphasizing the importance of HPV vaccination for boys.

Kathleen Schmeler, M.D.
Human Papillomavirus Vaccination   Top of Page
Presenter: Kathleen Schmeler, M.D.
Associate Professor, Gynecologic Oncology and Reproductive Medicine

Summary: In the United States, an estimated 14 million persons are newly infected annually with genital human papillomavirus (HPV), making this infection the nation’s most common sexually transmitted infection. In 2009, nearly 35,000 HPV-attributable cancers were reported in the United States. Of these, 39% occurred in males. The CDC Advisory Committee on Immunization Practices currently recommends routine HPV vaccination for all persons aged 11–12 years.  In her lecture, “Human Papillomavirus (HPV) Vaccination,” Kathleen Schmeler, MD, Associate Professor in the Department of Gynecologic Oncology and Reproductive Medicine, explains the epidemiology of cervical cancer and how to screen for and treat cervical cancer. Specific vaccine recommendations and the role of HPV vaccination in preventing cervical cancer are presented.




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